Hebephilia

Hebephilia is the strong and persistent adult sexual interest in pubescent (early adolescent) individuals, typically ages 11–14 (see the Tanner stage). It differs from ephebophilia, which is the strong and persistent sexual interest to those in later adolescence, approximately 15–19 years old,[1][2] and from pedophilia,[2] which is the primary or exclusive sexual attraction to prepubescent children.[3][4][5] While individuals with a sexual preference for adults may have some sexual interest in pubescent-aged individuals,[2][6] researchers and clinical diagnoses have proposed that hebephilia is characterized by a sexual preference for pubescent rather than adult partners.[2][7]

Hebephilia is approximate in its age range because the onset and completion of puberty vary. Partly because of this, some definitions of chronophilias (sexual preference for a specific physiological appearance related to age) show overlap between pedophilia, hebephilia and ephebophilia;[2] for example, the DSM-5 extends the prepubescent age to 13,[3] the ICD-10 includes early pubertal age in its definition of pedophilia,[8] and some definitions of ephebophilia include adolescents aged 14 to late adolescents. On average, girls begin the process of puberty at age 10 or 11; boys at age 11 or 12,[9] and it is argued that separating sexual attraction to prepubescent children from sexual attraction to early-to-mid or late pubescents is clinically relevant.[1][2]

According to research by Ray Blanchardet al. (2009), sex offenders could be separated into groups by victim age preference on the basis of penile plethysmograph response patterns. Based on their results, Blanchard suggested that the DSM-5 could account for these data by subdividing the existing diagnosis of pedophilia into hebephilia and a narrower definition of pedophilia.[1] Psychologist Bruce Rind and sociologist Richard Yuill have published criticism of the classification of hebephilia as a mental disorder, though their view is that Blanchard et al. successfully established hebephilia as a "genuine sexual preference"; they suggested that if hebephilia were listed in the DSM-5, that it be coded as a condition that results in significant social problems today.[10] Blanchard's proposal to add hebephilia to the DSM-5 proved controversial,[2][11] and was not adopted.[12]

Hebephilia is defined as a chronophilia in which an adult has a strong and persistent sexual interest in pubescent-aged individuals, generally aged 11–14, although the age of onset and completion of puberty vary.[2] The DSM-5's diagnostic criteria for pedophilia and the general medical literature defines pedophilia as a disorder of primary or exclusive sexual interest in prepubescent children, thus excluding hebephilia from its definition of pedophilia.[3][4][5] However, the ICD-10 diagnostic code for the definition of pedophilia partially overlaps with the definition of hebephilia, as the ICD-10 defines pedophilia as a sexual preference for children of prepubertal or early pubertal age.[8] There is also a partial overlap of hebephilia with ephebophilia, which is sometimes defined as a sexual preference for mid-to-late adolescents aged 14 (or 15) to 19.

The term hebephilia is based on the Greek goddess and protector of youth Hebe, but, in Ancient Greece, also referred to the time before manhood in Athens (depending on the reference, the specific age could be 14, 16 or 18 years old). The suffix-philia is derived from -phil-, implying love or strong friendship.[13]

The term was first used in 1955, in forensic work by Hammer and Glueck.[14] Anthropologist and ethno-psychiatrist Paul K. Benedict used the term to distinguish pedophiles from sex offenders whose victims were adolescents.[15]Karen Franklin, a forensic psychologist, traced the history of use of the term in a 2010 article. She states that it is a variation of ephebophilia, used by Magnus Hirschfeld in 1906 to describe homosexual attraction to males between puberty and their early twenties, who considered the condition normal and nonpathological. Historically, criminal hebephilic acts where victims were "biologically ready for coitus" (i.e., statutory rape) were considered distinct from other forms of criminal sexuality such as rape and pedophilia, with wide variations within and across nations regarding what age was acceptable for adult-adolescent sexual contacts.[16]

Franklin has stated that she believes the concept is largely the result of the Centre for Addiction and Mental Health,[16] though CAMH employee and clinical psychologist James Cantor challenged the factual accuracy of this claim, citing the existence of the concept in the ICD-10,[17] the use of the word in 100 scholarly texts from a variety of disciplines and time periods, and the existence of 32 peer reviewed papers researching the concept.[18]

The prevalence of hebephilia within the general population is unknown. There is evidence suggesting that within clinical and correctional samples,[24][25] as well as anonymous surveys of people sexually interested in children, there are more individuals with an erotic interest in pubescent rather than in prepubescent children.[26][27]

A 2009 research paper by Ray Blanchard and colleagues indicated that, based on penile plethysmographs, sex offenders could be grouped according to the sexual maturity of individuals they found most attractive (because ages are not a specific indication of adolescent sexual development, Blanchard used stimuli with a Tanner scale rating of 1 on essentially all measures to evaluate hebephilic offenders while adult control stimuli all had a Tanner rating of 5).[1] Blanchard noted that the most common age of victims for sexual offenders was 14 years, and suggested there were qualitative differences between offenders who preferred pubertal sex-objects and those with a prepubertal preference. The paper concluded that the DSM-5 could better account for those data if it split the DSM-IV-TR's existing criteria for pedophilia, which focuses on sexual attraction to prepubescent children, but sets the age range at generally 13 or younger.[1]

Blanchard suggested the criteria be split into pedophilia as sexually attracted to prepubescent children who are generally younger than 11, and hebephilia as sexual attraction to pubescent children, generally 11–14 years old. What DSM-IV calls pedophilia would instead be termed pedohebephilia, with pedophilic and hebephilic sub-types.[1] The proposed criteria for the DSM-5 involved an adult who, for six or more months, experienced sexual attraction to prepubescent or pubescent children that was equal to or greater than their attraction to adults, and who also either found the attraction distressing, used child pornography or had sought sexual stimulation from a child, on at least three occasions in the case of the hebephilic type. The proposed criteria would have been applied to subjects aged 18 or older and who are at least five years older than children to whom they are typically attracted.[11] The sexual and gender identity working group justified inclusion of the use of child pornography due to the expectation that pedohebephilic individuals would deny their sexual preferences, leaving it up to the diagnosing clinician to make inferences whether their patients are more interested in children than adults.[28] The altered wording (from "prepubescent" to "prepubescent and pubescent") and reference age (from a maximum age of 13 to 14) would change how pedophilia was diagnosed to include victims with Tanner scale ratings of 2 or 3 who had developed some secondary sexual characteristics.[29]

The proposal was presented at a 2009 meeting of the American Academy of Psychiatry and the Law along with several other prospective changes to the DSM's treatment of paraphilias. Participants questioned whether sexual attraction to pubesecent children can be considered abnormal in a context where their sexualization is to a certain extent normative. Concern was also raised that the criteria could have produced both false positives and false negatives; hebephilia as a DSM diagnosis could pathologize sex offenders who have opportunistically preyed on pubescent victims but do not have a paraphilic attachment to a specific age of victim, but could exclude offenders who had committed serious offences on only one or two victims.[30] During academic conferences for the American Academy of Psychiatry and Law and International Association for the Treatment of Sexual Offenders, symbolic votes were taken regarding whether the DSM-5 should include pedohebephilia, and in both cases an overwhelming majority voted against this.[31]

In a letter to the editor, clinical psychologist Joseph Plaud criticized the study for lacking control groups for post-pubescent and normal patterns of male sexual arousal, overlap between groups Blanchard believed were separate, and lack of specificity in the data.[32] Blanchard replied that the initial publication used sex offenders who had committed crimes against post-pubescent adults as a control group, and that the results supported victim age preferences being a continuous rather than categorical variable.[33] In separate letters to the editor, forensic psychologist Gregory DeClue and mathematician Philip Tromovitch agreed the term would be valuable for research purposes and to subdivide the current diagnosis of pedophilia into victim age preferences, but expressed concern that the term's potential to dramatically expand the number of people diagnosed with a paraphilia without an adequate research base to support it and the article did not include a definition of "mental disorder" and thus lacking the ability to distinguish the pathological from the non-pathological.[34][35] Blanchard stated in a reply that his paper was written under the assumptions that the DSM-5's definition of mental disorder and pathologizing of sexual activity with underaged individuals would be similar to the one found in DSM-IV.[33]

Karen Franklin has criticized use of the term hebephilia for pathologizing and criminalizing a "widespread and, indeed, evolutionarily adaptive" sexual attraction of homosexual and heterosexual males who, across cultures and throughout history "tend to prefer youthful partners who are at the peak of both beauty and reproductive fertility".[16] Franklin also objects to the use of hebephilia during trials of individuals who may be imprisoned on the basis of sexually violent predator laws in the United States.[16] A similar comment was made by DSM-IV editors Michael First and Allen Frances;[29] First also questioned the degree to which hebephilic offenders might be opportunistically preying on vulnerable adolescents rather than expressing a pathological desire.[30] Commenting on Blanchard et al.'s proposal, psychologists Robert Prentky and Howard Barbaree pointed out that examples of highly sexualized young girls appear frequently in advertising, fashion shows, television programs, and films, making it questionable whether sexual attraction to pubescents is abnormal.[2]

Blanchard responded to Franklin's comment in a letter to the editor, writing that presumably Franklin's "adaptationist argument" applied only to heterosexual males, as homosexual hebephilia would have no reproductive advantages. Blanchard cited recent research he had conducted regarding the alleged reproductive success of hebephiles, pedophiles and teleiophiles (individuals attracted primarily or exclusively to adults).[36] The results indicated that teleiophiles had more children, and thus more adaptive success than hebephiles, while hebephiles had more success than pedophiles. From this, Blanchard concluded that "there is no empirical basis for the hypothesis that hebephilia was associated with increased reproductive success in the environment of evolutionary adaptedness. That speculative adaptationist argument against the inclusion of hebephilia in the DSM cannot be sustained".[37]

Professor of social work Jerome Wakefield described the inclusion as an inappropriate extension of the existing well-validated category of pedophilia, which would carry significant risk of false positives, and ignored the large qualitative distinctions between prepubescent children and sexually mature pubescents. He summarized his discussion with the statement "it appears that the hebephilia proposal is one where criminality and social disapproval are being confused with mental disorder".[11] However, child sexual abuse researcher William O'Donohue believes, based on the incentive for offenders to lie, that there is a far greater risk of false negatives. O'Donohue praised Blanchard et al.'s proposal to distinguish hebephilia from pedophilia, but questioned the inclusion of offender distress, the use of child pornography as a determining factor and requiring a minimum of three victims, believing the latter choice would result in delayed treatment for hebephiles who have not acted on their urges while ignoring the often hidden nature of child sexual abuse. O'Donohue also had concerns over how information for making decisions about the proposed diagnosis would be acquired, whether the diagnosis could be made with reliability and sufficient agreement between clinicians and issues related to treatment.[38] Clinical and forensic psychologist Thomas Zander noted problems in distinguishing between prepubescent versus pubescent victims, and thus the difficulty in classifying offenders and the degree to which the potential diagnosis genuinely reflected normal versus abnormal sexual desire.[39]

In a letter to the editor, sexologist, lawyer, and gender identity specialist Richard Green questioned whether sexual attraction to pubescent sexual partners was a mental health issue, analogizing the proposal to the decision to include homosexuality in earlier versions of the DSM which turned a sexual orientation into a mental disorder. Green also questioned the proposal's impact on the credibility of the APA, its potential to blur the distinction between psychiatry and law, and whether it was necessary to create mental disorders for criminal acts. Green agreed the term would be useful for research purposes but disagreed with efforts to include it in the DSM-5.[40] Prentky and Barbaree note that Blanchard et al. had identified Green's "law/psychiatry blur" in their initial article, but suggest distinctions can be made between normative attraction to pubescent girls and the exclusivity, disability, distress, and impairment that would characterize hebephilia as paraphilic.[2]

In 1996, the Supreme Court of the United States legalized the use of civil commitment (also known as involuntary commitment) to indefinitely detain dangerous sex offenders, with legislation enacted first in Kansas, then in 20 other states and the federal government.[41] Some, but not all, state-level courts have used controversial paraphilias to justify civil commitments,[41][42] including paraphilia NOS, paraphilic rape and hebephilia, though the Supreme Court has not provided an opinion on their specific uses in courtrooms. Typically commitment decisions are made on the basis of three criteria (a history of sex crimes, some sort of mental disorder and a belief that they are likely to continue offending), and the most common mental disorders used in proceedings include pedophilia, antisocial personality disorder, paraphilia NOS (generally paraphilic rape and hebephilia), substance abuse and unspecified personality disorders. Forensic assessments provided by mental health experts heavily inform these proceedings, though the fit between legal and mental health systems is imperfect and experts disagree regarding the importance, authority, use, reliability, validity, and necessity of the DSM and its diagnoses.[29][41]

Considerable concern has been expressed regarding the potential for hebephilia to be used to indefinitely detain sex offenders with adolescent victims through involuntary commitment. According to Prentky and Barbaree its proposed inclusion in the DSM-5 was "for self-serving reasons, [...] applauded by those who generally work for the prosecution and criticized by those who generally work for the defense. This is an admittedly cynical, if unfortunately accurate, commentary on the influence of adversarial litigation on clinical deliberation".[2] Hebephila has been challenged in involuntary commitment proceedings for failing to be included in the DSM and the questionable abnormality of being attracted to adolescent children (particularly within the context of different cultures). Another concern is the exclusivity of offenders' attraction to adolescents, particularly when the majority of offenders have a history of offending against adults. There is no clear professional consensus regarding its use; experts used by the criminal defense minimize or dismiss hebephilia's use in the courts, while experts used by criminal prosecutors recognize its presence in the DSM through the diagnosis of paraphilia NOS. It was thought that inclusion of hebephila in the DSM-5 would increase its use in court and the total number of involuntary commitments. The advent of involuntary commitment laws in the United States has been cited as the reason for the increase in interest in the term, though forensic psychologist John Fabian has noted the lack of consensus over the definition and use of the term within courts.[41] Allen Frances and Michael First believe the proposal to include hebephilia in the DSM-5 was inappropriate; in addition to its potential misuse in civil commitment hearings, they stated the need, rationale and evidence provided were inadequate.[29] Frances wrote that the diagnosis of hebephilia "has no place in forensic proceedings."[43]

In a letter to the editor by Thomas Zander, serious consequences of expanding the definition of pedophilia to include hebephilia were additionally expressed. Zander noted that the diagnosis would incorporate age ranges in which sexual activities were legal under age of consent laws within the United States and concluded that the term should require more research and consideration of implications before the DSM were changed.[39] Blanchard agreed that distinguishing between pedophiles and hebephiles may present difficulties, but stated that in the case of a repeat sexual offender, these fine distinctions would be less important; he noted that other objections raised by Zander's letter were addressed in the original article.[33] Psychologist Douglas Tucker and lawyer Samuel Brakel stated in another letter to the editor that civil commitment as a sexually violent predator does not require a DSM diagnosis, so long as the clinicians who testify in courts do so in good faith and identify conceptually and empirically meaningful mentally abnormality that is predictive of future sexual violence, irrespective the term used.[44] In a third letter to the editor, physician Charles Allen Moser agreed with Blanchard et al.'s premise that there was a distinction between sex offenders who preferred pubescent versus prepubescent victims and supported the term's usefulness in conducting research, but questioned whether hebephilia would represent a true paraphilia.[7] Moser argued what he saw as the problematic use of paraphilic labels to pathologize unusual sexual interests and incarcerate individuals on the basis of their paraphilia rather than their behavior. He also questioned the usefulness of paraphilias in general when the real issue may be criminal behaviours or stigmatization of unusual but benign and/or consensual sexual acts.[7]

Forensic psychologist Charles Patrick Ewing defined hebephilia as "the sexual attraction of an adult to a pubescent (i.e., sexually mature) person who is under the age of consent" and "criticized the diagnosis as a "transparent effort to ensure [that] eligible sex offenders [who target pubescent teenagers] may be subject to a diagnosis for [civil commitment] purposes".[42] Ewing noted the proposed diagnosis was controversial,[42] and was rejected in one United States federal court in 2009 for being a label, not a "generally accepted mental disorder" and because a mere attraction to adolescents is not indicative of mental disorder.[45]

Psychiatrist Howard Zonana believes people should not be declared sexual predators, considering such labels a misuse of psychiatry.[46] In a 2011 commentary, he questioned the DSM-5 proposals to change the Pedophilia/Pedohebephilia cut-off from 13 to 14, as well as the proposal to name Hypersexual Disorder and Paraphilic Coercive Disorder, believing that the changes conflate mental illness with law enforcement.[28]

In a 2015 essay, historian and philosopher of science Patrick Singy locates the hebephilia debate and Sexually Violent Predator laws in the broader context of modern liberal thought.[47]

^Cantor in his 2012 rebuttal in the International Journal of Forensic Mental Health states "The current version of the International Classification of Diseases (ICD-10) contains code F65.4, which defines paedophilia as 'A sexual preference for children, boys or girls or both, usually of prepubertal or early pubertal age' (World Health Organization, 2007; emphasis added). That is, people with a sexual preference for early pubescent children do indeed receive a diagnosis in the ICD system. In Franklin's defense, one could claim that the word 'hebephilia' does not appear in the ICD; however, the people with hebephilia would receive a diagnosis nonetheless."

^ abZonana, H. (2011). "Sexual disorders: New and expanded proposals for the DSM-5--do we need them?". The journal of the American Academy of Psychiatry and the Law. 39 (2): 245–249. PMID21653273.

^ abcdFrances, A.; First, M. B. (2011). "Hebephilia is not a mental disorder in DSM-IV-TR and should not become one in DSM-5". The journal of the American Academy of Psychiatry and the Law. 39 (1): 78–85. PMID21389170.